Zimmerli W, Girardet G, Nassiopoulos K, Hahnloser P, Petropoulos P
Service de chirurgie générale, Hôpital cantonal, Fribourg.
Helv Chir Acta. 1993 Sep;60(1-2):71-3.
We reviewed in a retrospective study all our 616 electively operated colons over 15 years from 1976 to 1990 for morbidity and mortality depending the antibiotic prophylaxis. Interventions were performed on 578 patients with a mean age of 65.5 + 13.7 years; in 38 cases there was an earlier elective colic operation. The sex ratio was 1.26 men to 1 woman. 71.8% of the indications were adenocarcinomas of the colon. All other diagnostics, as well as different types of interventions were included in the study. All interventions was preceded by large bowel preparation. The colic anastomosis were almost always handswen in two layers. Until 1982 systematically, we gave prophylaxis by combination of aminoglycoside with metronidazole or clindamycin, n = 329 (53.4% of 616). We then changed to ceftriaxone, n = 287 (46.6% of 616). Ceftriaxone was applied in single dose (n = 142), in multi doses (n = 71) and combined in almost all cases with metronidazole (n = 74). We found significantly better morbidity and mortality results with ceftriaxone than in the aminoglycoside combined group: The ceftriaxone group had a septicemia or colocutaneous fistulas requiring reoperation incidence of 1.4% (4/287) versus 4.6% (15/329) (p = 0.023). Mortality decreased from 4.9% (16/329) under aminoglycoside combined prophylaxis to 1.74% (5/287) in the ceftriaxone group (p = 0.033). The infection rate of the surgical accesses diminished from 13.1% (43/329) to 8% (23/287) under ceftriaxone (p = 0.043).(ABSTRACT TRUNCATED AT 250 WORDS)
